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My husband has just been diagnosed with mild psoriasis on his genitals. He also had an injury a year ago in his big toenail, and today I can assume that he has nail psoriasis too because the condition looks like the psoriasis nail images I have seen. He has also been (for 10 years now) complaining of pain in his knee joint, but the doctor diagnosed a syndrome that cannot be treated with anything else but anti-inflammatory medicine and lots of rest. Should we ask for advice from a rheumatologist, or should we just treat the skin problems? Thanks.

This is a fairly common clinical scenario and can be summed up as, "When should psoriatic arthritis be considered as the cause of joint pain in a patient with psoriasis?"

Based on what you’ve told me, it sounds a bit like your husband’s doctor suspects osteoarthritis, which is very, very common. However, it is not unreasonable to see a rheumatologist, particularly if the pain is not adequately controlled (and typically there is no harm in a second opinion).

If it turns out that your husband does have psoriatic arthritis, that doesn’t necessarily mean that he needs systemic medications. But I do feel that a rheumatologist is best suited to make that decision and follow any potential progression of joint disease.

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